title: A strategy of rapid cardioversion minimizes the significance of early recurrent atrial tachyarrhythmias after ablation for atrial fibrillation.
abstract: BACKGROUND
  The significance of early recurrent atrial tachyarrhythmias after atrial fibrillation (AF) ablation is unclear. Atrial remodeling driven by these tachyarrhythmias can result in electrical, contractile, and structural changes that may impair long-term therapy success. Aggressive attempts to restore sinus rhythm in the temporal period of healing after ablation might improve outcomes.
  
  
  METHODS
  A total of 1,759 AF ablations were performed at Intermountain Medical Center or LDS Hospital. A total of 455 of those were among patients requiring repeat ablations. Patients were instructed to take their pulse daily and, if greater than 100 bpm or irregular, present the following business day fasting to the clinic for evaluation and cardioversion if AF or atrial flutter (AFL) were present.
  
  
  RESULTS
  Of the ablations performed, a total of 515 (29%, age: 65.6 ± 11.2 years, male: 57.9%) developed AF/AFL that required cardioverison. The majority of these arrhythmias first occurred in the initial 90 days (63.7%) postablation. During this period, 62.8% were on an antiarrhythmic drug (AAD). Only 25.1% were using an AAD at 3 months. The majority of ablations (75.6%) who experienced AF/AFL within the first 90 days after ablation were in sinus rhythm with no AAD at 1 year. Further, 48% of those with the first recurrence from 90 to 180 days were in sinus rhythm with no AAD at 1 year.
  
  
  CONCLUSIONS
  The time at which the first recurrence of AF/AFL occurs impacts long-term outcomes. An aggressive strategy of rapid cardioversion postablation reduces the significance of recurrent AF/AFL during the first 6 months.
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Gangadhar
authors.initials: G
authors.lastname: Malasana
authors.forename: John D
authors.initials: JD
authors.lastname: Day
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.forename: Brian G
authors.initials: BG
authors.lastname: Crandall
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Osborn
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappe
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nelson
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D016208:Databases, Factual; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D055502:Secondary Prevention; D013610:Tachycardia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors